Provider Demographics
NPI:1063021491
Name:HANNA, NADA MAURICE IBRAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:NADA
Middle Name:MAURICE IBRAH
Last Name:HANNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25069 MOUND ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2770
Mailing Address - Country:US
Mailing Address - Phone:615-752-6010
Mailing Address - Fax:
Practice Address - Street 1:25069 MOUND ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2770
Practice Address - Country:US
Practice Address - Phone:615-752-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist